The American Thoracic Society (ATS) developed criteria for the diagnosis of refractory asthma. These can help identify a patient in a high risk category who requires more aggressive management.


Patient selection:

(1) generally adherent to the treatment regimen

(2) other conditions excluded

(3) exacerbating factors have been identified and treated


Major criteria:

(1) oral corticosteroids taken >= 50% of previous year (near continuous or continuous)

(2) requires high dose inhaled corticosteroid therapy (see previous section)


Minor criteria:

(1) requires daily controller medication in addition to inhaled corticosteroids

(2) requires short-acting beta-agonist on daily or near daily basis to control symptoms

(3) has persistent airway obstruction

(4) >= 1 urgent or emergency care visits for asthma in the past year

(5) >= 3 steroid "bursts" in the past year

(6) clinical deterioration shortly after any attempt to reduce oral or inhaled corticosteroid dose by <= 25% (steroid dependent)

(7) >= 1 near fatal asthma event in the past



• Persistent airway obstruction was defined as FEV1 less than 80% of predicted AND diurnal peak expiratory flow (PEF) variability > 20%.

• Daily controller medications include a long acting beta-agonist, theophylline, or a leukotriene antagonist.


Diagnosis of refractory anemia requires both of the following:

(1) at least 1 major criterion

(2) at least 2 minor criteria


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